Gastroenterology Coding Alert

Question: Will Medicare cover the new telephone evaluation services (99441-99443) in 2008?

California Subscriber

Answer: No. Medicare has made these noncovered services in 2008. But the Medicare Physician Fee Schedule does assign relative value units (RVUs) to the codes. When negotiating for private-payer coverage, you can point to these total values:

• $13.46 for 99441 (Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion),

• $25.01 for 99442 (... 11-20 minutes of medical discussion)

• $37.14 for 99443 (...21-30 minutes of medical discussion).

Note: You would arrive at these amounts using the conversion factor (CF) of 37.8975. This was the 2006 rate Congress froze for 2007. Many suspect that Congress will freeze the CF rate for 2008.